Zeoli Tyler, Chanbour Hani, Ahluwalia Ranbir, Abtahi Amir M, Stephens Byron F, Zuckerman Scott L
Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
Diagnostics (Basel). 2024 May 20;14(10):1058. doi: 10.3390/diagnostics14101058.
Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, we sought to (1) determine the rate of ED presentation, (2) identify preoperative and perioperative risk factors associated with ED presentation, and (3) evaluate whether ED vs. clinic presentation impacts long-term outcomes.
A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions.
A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, = 0.043). Preoperative KPS was lower in ED patients ( < 0.001), while the Bilsky score was higher ( = 0.049). ED patients had higher rates of oligometastatic disease ( = 0.049), higher total decompressed levels ( = 0.041), and higher rates of costotransversectomy ( = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13-2.08, = 0.006).
Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation.
约20%的转移性脊柱疾病患者会出现症状性脊髓压迫，这些患者可能会紧急前往急诊科（ED）就诊，或者以更有序的方式前往诊所。在一组接受转移性脊柱手术的患者中，我们试图（1）确定急诊科就诊率，（2）识别与急诊科就诊相关的术前和围手术期风险因素，以及（3）评估急诊科就诊与诊所就诊对长期预后的影响。
对2010年2月至2021年1月期间接受转移性脊柱肿瘤手术的患者进行了一项单机构、多外科医生的回顾性队列研究。主要暴露变量是就诊地点，分为急诊科与诊所。主要结局是术后功能状态，用卡诺夫斯基功能状态量表（KPS）和麦考密克量表（MMS）测量，局部复发（LR）和总生存期（OS）。次要结局包括并发症和再入院。
共有311例患者接受了转移性脊柱手术（51.7%在急诊科就诊，48.3%在诊所就诊）。在急诊科就诊的患者吸烟率更高（21.7%对16.0%，P = 0.02），更有可能有2种及以上合并症（47.2%对32.7%，P = 0.011），并且更有可能拥有公共保险（43.5%对32.0%，P = 0.043）。急诊科患者术前KPS较低（P < 0.001），而比斯凯评分较高（P = 0.049）。与诊所患者相比，急诊科患者寡转移疾病发生率更高（P = 0.049），总减压节段更多（P = 0.041），肋横突切除术发生率更高（P = 0.031）。急诊科患者住院时间明显更长（7.7±6.1天对6.1±5.8天，P = 0.020），并且出院回家的可能性更小（52.2%对69.3%，P = 0.025）。急诊科就诊与总生存期缩短显著相关（HR = 1.53，95%CI = 1.13 - 2.08，P = 0.006）。
在接受转移性脊柱疾病手术的患者中，约一半是通过急诊科而非诊所就诊。急诊科患者吸烟率、公共保险率更高，比斯凯评分也更高。急诊科患者还接受了更广泛的手术，住院时间更长，出院回家的可能性更小，最重要的是，总生存期更短。这些结果表明，转移性脊柱疾病手术患者的初始就诊情况对预后有显著影响，应尽早识别转移性脊柱疾病的体征/症状以避免急诊科就诊。
